The Effect of Aging on Artificial Saliva at Different pH Values on the Color Stability of New Generation Denture Base Materials

STATEMENT OF PROBLEM

New-generation denture base materials are used successfully in denture fabrication; however, the effect of saliva pH change on the color stability of materials is unknown.

PURPOSE

The purpose of this in vitro study is to evaluate the color stability of new-generation denture base materials after immersion in artificial saliva with different pH values (3,7,14).

MATERIAL AND METHODS

Disc-shaped samples (Ø 10 mm x 2 mm) were prepared from three different denture base materials (1 pre-polymerized polymethylmethacrylate [PMMA], 1 graphene-reinforced PMMA, and heat-cure polymethyl methacrylate resin) (n=10). After polishing, color coordinates were measured using a PCE-CSM 5 colorimeter programmed in the CIE system (L* a* b*). The samples were kept in artificial saliva at different pH values and 37°C for 21 days. At the end of 21 days, color coordinates were measured again. The suitability of the measurements for a normal distribution was examined with the Kolmogro-Smirnov test. Whether color measurements obtained at different pH levels differed according to groups was examined with the Kruskal-Wallis test. The correlation between the CIEDE2000 and CIELab color difference formulas was examined by correlation analysis.

RESULTS

The highest color difference occurred in heat-cure samples at pH 3 (p<0.001). The color difference at different pH values was least observed in pre-polymerized PMMA samples. Significant color differences occurred in the graphene-reinforced pre-polymerized PMMA group at pH 7 (p<0.001).

CONCLUSIONS

It was observed that color differences occurred in all groups. Dentures made of new-generation CAD/CAM PMMA, which are less exposed to color differences, can be recommended for elderly patients with systemic diseases who are frequently exposed to pH changes in the oral cavity.

CLINICAL IMPLICATIONS

Color differences on denture surfaces over time negatively affect aesthetics. Since pH changes cause changes on the prosthesis surface, it may be recommended for these patients to fabricate dentures from new-generation CAD/CAM PMMA resins, which are less deformable.

A Review of the Role of Natural Products as Treatment Approaches for Xerostomia

Xerostomia, commonly known as dry mouth, is a widespread oral health malfunction characterized by decreased salivary flow. This condition results in discomfort, impaired speech and mastication, dysphagia, heightened susceptibility to oral infections, and ultimately, a diminished oral health-related quality of life. The etiology of xerostomia is multifaceted, with primary causes encompassing the use of xerostomic medications, radiation therapy to the head and neck, and systemic diseases such as Sjögren's syndrome. Consequently, there is a growing interest in devising management strategies to address this oral health issue, which presents significant challenges due to the intricate nature of saliva. Historically, natural products have served medicinal purposes, and in contemporary pharmaceutical research and development, they continue to play a crucial role, including the treatment of xerostomia. In this context, the present review aims to provide an overview of the current state of knowledge regarding natural compounds and extracts for xerostomia treatment, paving the way for developing novel therapeutic strategies for this common oral health issue.

Quantifying the Release of Titanium From the Titanium Dioxide-Impregnated Composites Used in Orthodontic Bonding

BACKGROUND

Previous literature data has extensively assessed the biocompatibility of various orthodontic adhesives and their components, where the results of most of the studies showed cytotoxic effects of different degrees owing to the unbound molecules released structurally from the cured components.

AIM

The present in-vitro study was aimed to assess the release of titanium dioxide nanoparticles in the artificial saliva from the orthodontic composites impregnated with titanium dioxide nanoparticles of 5% w/w (weight/weight) and 1% w/w used for metal brackets bonding.

METHODS

The study assessed 160 teeth extracted freshly during orthodontic treatment and divided into two groups of 80 samples, each that bonded to orthodontic brackets having 5% w/w and 1% w/w composites with titanium dioxide nanoparticles kept in the artificial saliva. Quantification was done for 5% w/w and 1% w/w composites having titanium nanoparticles with inductively coupled plasma mass spectroscopy at 24 hours, two, four, and six months.

RESULTS

It was seen that in teeth with 1% titanium dioxide, the greatest titanium release was seen at two months, with non-significant release after two months. In teeth with 5% w/w titanium dioxide nanoparticles showed significant titanium release all the time. A significantly greater titanium dioxide release on increasing concentration from 1% to 5% was seen for the 5% w/w group at all the assessment times.

CONCLUSION

The present study concludes that a higher release of titanium is seen in 5% w/w composite containing titanium dioxide nanoparticles, and the concentrations of 1% and 5% can be safely used and are considered to be within permissible limits.

A Comparative Evaluation of the Effect of Different Beverages on Colour Stability and Surface Micromorphology of Nanocomposite Restorative Material

AIM

This investigation was carried out to evaluate the color stability of a nanocomposite restorative material and the erosive potential of carbonated soft drinks (Coca-Cola; The Coca-Cola Company, Atlanta, Georgia, United States) and packaged orange juice (Real Fruit Power Orange; Dabur Ltd, Ghaziabad, Uttar Pradesh, India) on its surface micromorphology.

MATERIALS AND METHODS

Sixty discs (2mm thick and 10mm diameter) of nanocomposite material (Herculite Précis; KaVo Kerr, Brea, California, United States) were prepared using a silicon cylindrical mold. Initially, all the specimens were stored in artificial saliva in five Petri dishes; 12 specimens in each dish. In the Petri dishes, the specimens were immersed in the respective beverages once or twice a day. Before and after each immersion, the specimens were stored in artificial saliva at room temperature. Artificial saliva was changed each day, i.e., every 24 hours. The whole procedure was carried out for three months and then evaluated for color stability using a spectrophotometer and surface micromorphology using a scanning electron microscope. Now, the exposure of specimens to aerated drinks (Coca-Cola) and packaged orange juice (Real Orange) was put to a halt, and specimens were kept continuously in artificial saliva. This procedure was carried out for one month and then evaluated for color stability. The information was analyzed using PASW Statistics for Windows, Version 18.0 (Released 2009; SPSS Inc., Chicago, United States). A p-value of 0.05 was considered significant.

RESULTS

The p-value after three months, which is < 0.001 (p<0.05) indicates that the mean color difference values for groups I, II, III, IV, and V show a statistically significant change between the five groups, and similarly, the p-value after one month, which is < 0.001 (p<0.05) indicates that the mean color difference values for groups I, II, III, IV, and V show a statistically significant change between the five groups. Specimens immersed in the carbonated drink twice a day showed clinically more color change than packaged orange juice and artificial saliva on the composite restorative material. Coca-Cola, an aerated drink, was shown to have a higher erosive potential on the composite restorative material than Real Fruit Power Orange and fake saliva.

CONCLUSION

The findings are consistent with the hypothesis that repeated exposure to carbonated beverages (such as Coca-Cola and packaged juice) degrades the surface qualities of dental restorations.

Influence of Storing Composite Filling Materials in a Low-pH Artificial Saliva on Their Mechanical Properties-An In Vitro Study

Restorative composites are subjected to various influences in the oral cavity environment, such as high or low temperatures, the mechanical force generated during mastication, colonization of various microorganisms, and low pH, which may result from ingested food and the influence of microbial flora. This study aimed to investigate the effect of a recently developed commercial artificial saliva (pH = 4, highly acidic) on 17 commercially available restorative materials. After polymerization, the samples were stored in an artificial solution for 3 and 60 days and subjected to crushing resistance and flexural strength tests. The surface additions of the materials were examined in terms of the shapes and sizes of the fillers and elemental composition. When stored in an acidic environment, the resistance of the composite materials was reduced by 2-12%. Larger compressive and flexural strength resistance values were observed for composites that could be bonded to microfilled materials (invented before 2000). This may result from the filler structure taking an irregular form, which results in a faster hydrolysis of silane bonds. All composite materials meet the standard requirements when stored for a long period in an acidic environment. However, storage of the materials in an acid environment has a destructive impact on the materials' properties.

The Impact of Commercially Available Dry Mouth Products on the Corrosion Resistance of Common Dental Alloys

Dental implants are thought to be implanted for life, but throughout their lifespan, they function in aggressive oral environment, resulting in corrosion of the material itself as well as possible inflammation of adjacent tissues. Therefore, materials and oral products for people with metallic intraoral appliances must be chosen carefully. The purpose of this study was to investigate the corrosion behavior of common titanium and cobalt-chromium alloys in interaction with various dry mouth products using electrochemical impedance spectroscopy (EIS). The study showed that different dry mouth products lead to different open circuit potentials, corrosion voltages, and currents. The corrosion potentials of Ti64 and CoCr ranged from -0.3 to 0 V and -0.67 to 0.7 V, respectively. In contrast to titanium, pitting corrosion was observed for the cobalt-chromium alloy, leading to the release of Co and Cr ions. Based on the results, it can be argued that the commercially available dry mouth remedies are more favorable for dental alloys in terms of corrosion compared to Fusayama Meyer's artificial saliva. Thus, to prevent undesirable interactions, the individual characteristics of not only the composition of each patient's tooth and jaw structure, but also the materials already used in their oral cavity and oral hygiene products, must be taken into account.

Influence of Different Mouth Rinsing Agents on Friction During Sliding Mechanics Between Orthodontic Metal Brackets and Stainless Steel Archwire: A Comparative In Vitro Study

Aim and objectives The aim of this in-vitro study is to evaluate and compare the effect of various mouth rinsing agents on frictional resistance through sliding mechanics among orthodontic metal brackets and stainless steel (SS) archwire. Materials and methods Each group comprised 15 samples of maxillary first premolar pre-adjusted edgewise SS movable, un-bonded brackets (Koden Inc., United States) which were welded with a power arm, where 100 g of the load was suspended. Brackets were ligated with elastic modules (Koden Inc., United States) onto the perspex sheet along with 0.019" x 0.025" SS archwire (Classic Orthodontics, United States) and were suspended from the upper component of the Instron machine. The coefficient of friction was tested in dry conditions (control), artificial saliva (AS) (Wet Mouth, ICPA Health Product Ltd., India), 0.2% chlorhexidine gluconate (CHG) mouthwash (Hexidine, ICPA Health Product Ltd., India), 0.05% sodium fluoride (NaF) mouthwash (ACT Anti-Cavity Fluoride Mouthwash, Sanofi Company, United States), charcoal (CC) mouthwash (Hello Activated Charcoal Extra Freshening Mouthwash, Hello Products LLC, United States) and ozone-infused oil-pulling solution with coconut oil (O₃) (O₃ Essentials, Health Ranger Store, United States). In order to calculate the coefficient of friction, 50 L was added to the test sample while moving at a 5 mm/min crosshead speed. The groups were compared using the one-way analysis of variance (ANOVA), and Tukey's post hoc analysis was performed for multiple pairwise comparisons. Results The coefficient of friction with the highest mean values was observed with the control group (2.01), followed by AS (1.79), and the least with O₃ (1.15). Statistically significant differences were observed with almost all groups of mouth rinsing agents, but NaF is significant with CHG and CC. However, CHG did not have any significant difference from CC. Conclusions Lower coefficient of frictional values were observed with the ozone-infused oil-pulling solution with coconut oil during sliding mechanics between metal brackets and stainless steel archwire. Almost all the mouth rinsing agents showed a significantly different coefficient of friction value.

Evaluation of the Demineralization Development around Different Types of Orthodontic Brackets

The aim of this study was to compare the demineralizations of the enamel surfaces around different types of orthodontic brackets in an artificial cariogenic environment. A total of 90 extracted human maxillary first premolar teeth were used in this in vitro study. The teeth were divided into 6 groups, 5 study and 1 control, each consisting of 15 samples. Victory metal, Gemini metal, Clarity self-ligating ceramic, APC Clarity Advanced ceramic and Clarity Advanced ceramic brackets (3M Unitek, Monrovia, Calif) used in the study groups were bonded to the teeth with the direct technique. The gingival, occlusal and proximal enamel surfaces adjacent to the brackets were measured with a DIAGNOdent pen (KaVo, Biberach, Germany) (T0). Then, the teeth were placed in a cariogenic suspension environment containing Streptococcus mutans, sucrose and artificial saliva. The teeth were removed from the cariogenic suspension at the end of 28 days. Enamel surfaces were remeasured with DIAGNOdent and the values were recorded (T1). Whether the obtained data were homogeneously distributed or not was determined by the Kolmogorov-Smirnov test, within-group comparisons were performed with the Wilcoxon test, and between-group comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests. Significance level was accepted as p < 0.05. In all groups, the demineralization values of the enamel surfaces in the gingival, proximal and occlusal surfaces adjacent to the brackets were significantly higher in the T1 period than in the T0 period (p < 0.05). In the T1 period of Gemini metal, Clarity self-ligating ceramic and Clarity advanced ceramic bracket groups, the demineralization values of the proximal enamel surfaces were found to be significantly higher than the Victory metal and APC Clarity Advanced ceramic bracket groups (p < 0.05). In the T1 period, the demineralization values of the occlusal enamel surfaces of the Victory metal, APC Clarity Advanced ceramic bracket groups and control group were significantly lower than the Gemini metal, Clarity self-ligating ceramic and Clarity Advanced ceramic bracket groups (p < 0.05). Significant increases in enamel demineralization values were observed as a consequence of increased retention areas for microbial dental plaque on enamel surfaces adjacent to the bracket. Considering the importance of minimizing enamel demineralization in fixed orthodontic treatments, less enamel demineralization in Victory metal and APC Clarity Advanced ceramic bracket groups showed that these brackets can be preferred in patients with poor oral hygiene.

A new spray-based method for the in-vitro development of dry-surface biofilms

The inanimate environment immediately surrounding the patient in healthcare facilities is a reservoir of microorganisms embedded in dry-surface biofilms (DSB). These biofilms, first highlighted in 2012, are increasingly studied, but currently available in-vitro models only allow for the growth of semi-hydrated biofilms. We developed a new in-vitro method under actual dehydration conditions based on the hypothesis that surface contamination is mainly due to splashes of respiratory secretions. The main objective of this study was to show that the operating conditions we have defined allowed the growth of DSB with a methicillin resistant Staphylococcus aureus strain. The second objective was to show that extended-spectrum beta-lactamase-producing Enterobacteriaceae, that is, Klebsiella pneumoniae and Enterobacter cloacae were also able to grow such biofilms under these conditions. Monobacterial suspensions in sterile artificial saliva (SAS) were sprayed onto polyethylene surfaces. Nutrients and hydration were provided daily by spraying SAS enriched with 20% of Brain Heart Infusion broth. The primary outcome was mean surface coverage measured by image analysis after crystal violet staining. The method applied to S. aureus for 12 days resulted in reproducible and repeatable DSB consisting of isolated and confluent microcolonies embedded in extracellular polymeric substances as shown in scanning electron microscopy images. Similar DSB were obtained with both Enterobacteriaceae applying the same method. No interspecies variation was shown between the three strains in terms of surface coverage. These first trials are the starting point for a 3-year study currently in process.

Characterization of Metallic Off-Flavors in Drinking Water: Health, Consumption, and Sensory Perception

Characterization of taste- and flavor-producing metals, namely iron and copper, in drinking water is a multifaceted subject. Both metals are essential nutrients, can be toxic, and are known to produce unpleasant tastes and flavor sensations in drinking water. Ingestion of trace metal contaminants through drinking water is a probable source of human exposure. Biochemical mechanisms of metallic flavor perception have been previously described; however, less is known about how variations in salivary constituents might impact individuals' sensitivities to metallic flavors and beverage consumption behaviors. This research presents findings from in vitro experiments, using artificial human saliva, to better understand the role of salivary lipids and proteins on metallic flavor production as measured by biomarkers of metal-induced oxidative stress. The results indicate that metal-induced lipid oxidation, as measured by thiobarbituric acid reactive substances (TBARS), is dominated by salivary proteins, is slightly inhibited in the presence of salivary nitrite, and is detectable by the TBARS method at and above respective concentrations of 9 µM (0.5 mg/L) and 90 µM (5 mg/L), which are both above the aesthetic standards for iron (0.3 mg/L) and copper (1.0 mg/L) in drinking water. Preliminary study with human subjects indicated that reduction in metallic flavor sensitivity, as measured by the best estimate flavor threshold for ferrous iron among 33 healthy adults aged 19-84 years old (22 females), corresponded with reduced drinking water consumption and increased caloric beverage intake among older subjects (>60 years), as determined by a validated self-reported beverage intake questionnaire. These findings provide insights for further research to examine how salivary constituents can impact humans' sensory abilities in detecting metallic off-flavors in water, and how reduced metallic flavor sensitivity may influence beverage choices and drinking water consumption.

Degradation of Polylactide and Polycaprolactone as a Result of Biofilm Formation Assessed under Experimental Conditions Simulating the Oral Cavity Environment

Polylactide (PLA) and polycaprolactone (PCL) are biodegradable and bioabsorbable thermoplastic polymers considered as promising materials for oral applications. However, any abiotic surface used, especially in areas naturally colonized by microorganisms, provides a favorable interface for microbial growth and biofilm development. In this study, we investigated the biofilm formation of C. krusei and S. mutans on the surface of PLA and PCL immersed in the artificial saliva. Using microscopic (AFM, CLSM) observations and spectrometric measurements, we assessed the mass and topography of biofilm that developed on PLA and PCL surfaces. Incubated up to 56 days in specially prepared saliva and microorganisms medium, solid polymer samples were examined for surface properties (wettability, roughness, elastic modulus of the surface layer), structure (molecular weight, crystallinity), and mechanical properties (hardness, tensile strength). It has been shown that biofilm, especially S. mutans, promotes polymer degradation. Our findings indicate the need for additional antimicrobial strategies for the effective oral applications of PLA and PCL.

Effect of Graphene Sheets Embedded Carbon Films on the Fretting Wear Behaviors of Orthodontic Archwire-Bracket Contacts

Carbon films were fabricated on the orthodontic stainless steel archwires by using a custom-designed electron cyclotron resonance (ECR) plasma sputtering deposition system under electron irradiation with the variation of substrate bias voltages from +5 V to +50 V. Graphene sheets embedded carbon (GSEC) films were fabricated at a higher substrate bias voltage. The fretting friction and wear behaviors of the carbon film-coated archwires running against stainless steel brackets were evaluated by a home-built reciprocating sliding tribometer in artificial saliva environment. Stable and low friction coefficients of less than 0.10 were obtained with the increase of the GSEC film thickness and the introduction of the parallel micro-groove texture on the bracket slot surfaces. Particularly, the GSEC film did not wear out on the archwire after sliding against three-row micro-groove textured bracket for 10,000 times fretting tests; not only low friction coefficient (0.05) but also low wear rate (0.11 × 10^-6 mm³/Nm) of the GSEC film were achieved. The synergistic effects of the GSEC films deposited on the archwires and the micro-groove textures fabricated on the brackets contribute to the exceptional friction and wear behaviors of the archwire-bracket sliding contacts, suggesting great potential for the clinical orthodontic treatment applications.

Label-Free LSPR-Vertical Microcavity Biosensor for On-Site SARS-CoV-2 Detection

Cost-effective, rapid, and sensitive detection of SARS-CoV-2, in high-throughput, is crucial in controlling the COVID-19 epidemic. In this study, we proposed a vertical microcavity and localized surface plasmon resonance hybrid biosensor for SARS-CoV-2 detection in artificial saliva and assessed its efficacy. The proposed biosensor monitors the valley shifts in the reflectance spectrum, as induced by changes in the refractive index within the proximity of the sensor surface. A low-cost and fast method was developed to form nanoporous gold (NPG) with different surface morphologies on the vertical microcavity wafer, followed by immobilization with the SARS-CoV-2 antibody for capturing the virus. Modeling and simulation were conducted to optimize the microcavity structure and the NPG parameters. Simulation results revealed that NPG-deposited sensors performed better in resonance quality and in sensitivity compared to gold-deposited and pure microcavity sensors. The experiment confirmed the effect of NPG surface morphology on the biosensor sensitivity as demonstrated by simulation. Pre-clinical validation revealed that 40% porosity led to the highest sensitivity for SARS-CoV-2 pseudovirus at 319 copies/mL in artificial saliva. The proposed automatic biosensing system delivered the results of 100 samples within 30 min, demonstrating its potential for on-site coronavirus detection with sufficient sensitivity.

A Review on Xerostomia and Its Various Management Strategies: The Role of Advanced Polymeric Materials in the Treatment Approaches

The medical term xerostomia refers to the subjective sensation of oral dryness. The etiology seems to be multifactorial with the most frequently reported causes being the use of xerostomic medications, neck and head radiation, and systematic diseases (such as Sjögren’s syndrome). Xerostomia is associated with an increased incidence of dental caries, oral fungal infections, and difficulties in speaking and chewing/swallowing, which ultimately affect the oral health-related quality of life. The development of successful management schemes is regarded as a highly challenging project due to the complexity of saliva. This is why, in spite of the fact that there are therapeutic options aiming to improve salivary function, most management approaches are alleviation-oriented. In any case, polymers are an integral part of the various formulations used in every current treatment approach, especially in the saliva substitutes, due to their function as thickening and lubricating agents or, in the case of mucoadhesive polymers, their ability to prolong the treatment effect. In this context, the present review aims to scrutinize the literature and presents an overview of the role of various polymers (or copolymers) on either already commercially available formulations or novel drug delivery systems currently under research and development.

Cytotoxicity of Acrylic Resins, Particulate Filler Composite Resin and Thermoplastic Material in Artificial Saliva with and without Melatonin

There is limited information on the effect of melatonin on the cytotoxicity of dental materials. The study evaluated the cytotoxic effects of heat- and auto-polymerized acrylic resin, particulate filler composite resin and a thermoplastic material on L-929 fibroblast cell viability at different incubation periods in artificial saliva without and with melatonin. Disk-shaped specimens were prepared according to each manufacturer’s instructions and divided into two groups to be stored either in artificial saliva (AS) and AS with melatonin (ASM). The measurements were performed using an MTT (3-(4,5)-dimethylthiazol-2-yl)-2,5-diphenyl tetrazoliumbromide) assay, in which the L-929 mouse fibroblasts cell culture was used. For the MTT test, extracts were examined at 1, 24, 72 h and 1 and 2 weeks. Data were analyzed using 3-way ANOVA and Tukey’s tests. No significant difference was found between groups AS and ASM (F = 0.796; p = 0.373). Incubation period significantly affected all materials tested (p < 0.001). Storing resin-based materials in artificial saliva with melatonin solution for 24 h may reduce cytotoxic effects on the fibroblast cells for which the highest effect was observed. Soaking resin prosthesis or orthodontic appliances in artificial saliva with melatonin at least 24 h before intraoral use or rinsing medium containing melatonin may be recommended for decreasing the cytotoxicity of dental resin materials.

Effect of Cobalt and Chromium Ions on the Chlorhexidine Digluconate as Seen by Intermolecular Diffusion

Metal ions such as cobalt (II) and chromium (III) might be present in the oral cavity, as a consequence of the corrosion of Co-Cr dental alloys. The diffusion of such metal ions into the organism, carried by saliva, can cause health problems as a consequence of their toxicity, enhanced by a cumulative effect in the body. The effect of the chlorhexidine digluconate, which is commonly used in mouthwash formulations, on the transport of these salts is evaluated in this paper by using the Taylor dispersion technique, which will allow an assessment of how the presence of chlorhexidine digluconate (either in aqueous solution or in a commercial formulation) may affect the diffusion of metal ions. The ternary mutual diffusion coefficients of metal ions (Co and Cr) in the presence of chlorhexidine digluconate, in an artificial saliva media, were measured. Significant coupled diffusion of CoCl₂ (and CrCl₃) and chlorhexidine digluconate is observed by analysis of the non-zero values of the cross-diffusion coefficients, D₁₂ and D₂₁. The observed interactions between metal ions and chlorhexidine digluconate suggest that the latter might be considered as an advantageous therapeutic agent, once they contribute to the reduction of the concentration of those ions inside the mouth.

Changes in the Fermentation and Bacterial Community by Artificial Saliva pH in RUSITEC System

The purpose of the study was to assess the artificial saliva (AS) pH on ruminal fermentation and rumen bacteria community in the rumen simulation technique (RUSITEC) system. The experiment was performed in two treatments (low AS pH vs. high AS pH) with four replicates. The low AS pH was sustained by altering the composition of the AS (NaHCO₃ from 9.8 to 1.96 g/L, Na₂HPO₄ from 9.3 to 1.86 g/L) according to McDougall's method. The diets were supplemented with 16 g basic diets with forage to the concentrate ratio of 50:50. The experiments were conducted over 13-day incubation periods, with 9 days adaption and 4 days sample collection. The results showed low AS pH decreased dry matter (DM) degradability (64.37 vs. 58.67%), organic matter (OM) degradability (64.38 vs. 59.32%), neutral detergent fiber (NDF) degradability (46.87 vs. 39.94%), acid detergent fiber (ADF) degradability (38.16 vs. 31.13%), and crude protein (CP) degradability (70.33 vs. 62.99%), respectively. Compared with the high AS pH, the low AS pH increased the proportion of butyrate (P = 0.008) and decreased the proportion of propionate (P < 0.001). At the bacteria community, the low AS pH increased the abundances of Spirochaetes (P = 0.001) and Synergistetes (P = 0.004) and decreased the Verrucomicrobia abundance (P = 0.004) in solid-associated bacteria. At the genus level, the low AS pH increased the abundance of Lactobacillus (P = 0.050) and decreased the abundance of Schwartzia (P = 0.002) in solid-associated bacteria. The abundances of Prevotellaceae_YAB2003_group (P = 0.040), Schwartzia (P = 0.002), and Ruminobacter (P = 0.043) were lower in the low AS pH group compared with the high AS pH group in liquid-associated bacteria. Low AS pH decreased the number of Ruminococcus albus, Ruminococcus flavefaciens, Fibrobacter succinogenes (P < 0.001) both in the solid- and liquid-associated bacteria, respectively. The results of the present study included three groups of bacteria communities according to the different sensitives to rumen pH: the abundances of Lactobacillus, Succinivibrio, and Prevotella_7 are increased with decreasing AS pH; the amounts of R. albus, R. flavefaciens, F. succinogenes as well as the abundances of Schwartzia and Ruminobacter decreased with the reducing AS pH; the abundances of Selenomonas_1, Rikenellaceae_RC9_gut_group, and Succiniclasticum were not affected by the AS pH in RUSTITEC.

Sandwich Multi-Material 3D-Printed Polymers: Influence of Aging on the Impact and Flexure Resistances

With the advances in new materials, equipment, and processes, additive manufacturing (AM) has gained increased importance for producing the final parts that are used in several industrial areas, such as automotive, aeronautics, and health. The constant development of 3D-printing equipment allows for printing multi-material systems as sandwich specimens using, for example, double-nozzle configurations. The present study aimed to compare the mechanical behavior of multi-material specimens that were produced using a double-nozzle 3D printer. The materials that were included in this study were the copolymer acrylonitrile-butadiene-styrene (ABS), high-impact polystyrene (HIPS), poly(methyl methacrylate) (PMMA), and thermoplastic polyurethane (TPU). The configuration of the sandwich structures consisted of a core of TPU and the outer skins made of one of the other three materials. The mechanical behavior was evaluated through three-point bending (3PB) and transverse impact tests and compared with mono-material printed specimens. The effect of aging in artificial saliva was evaluated for all the processed materials. The main conclusion of this study was that the aging process did not significantly alter the mechanical properties for mono-materials, except for PMMA, where the maximum flexural stress decreased. In the sandwich structures, the TPU core had a softening effect, inducing a significant increase in the resilience and resistance to transverse impact. The obtained results are quite promising for applications in biomedical devices, such as protective mouthguards or teeth aligners. In these specific applications, the changes in the mechanical properties with time and with the contact of saliva assume particular importance.

Salivary Trefoil Factor Family (TFF) Peptides and Their Roles in Oral and Esophageal Protection: Therapeutic Potential

Human saliva is a complex body fluid with more than 3000 different identified proteins. Besides rheological and lubricating properties, saliva supports wound healing and acts as an antimicrobial barrier. TFF peptides are secreted from the mucous acini of the major and minor salivary glands and are typical constituents of normal saliva; TFF3 being the predominant peptide compared with TFF1 and TFF2. Only TFF3 is easily detectable by Western blotting. It occurs in two forms, a disulfide-linked homodimer (Mr: 13k) and a high-molecular-mass heterodimer with IgG Fc binding protein (FCGBP). TFF peptides are secretory lectins known for their protective effects in mucous epithelia; the TFF3 dimer probably has wound-healing properties due to its weak motogenic effect. There are multiple indications that FCGBP and TFF3-FCGBP play a key role in the innate immune defense of mucous epithelia. In addition, homodimeric TFF3 interacts in vitro with the salivary agglutinin DMBT1^gp340. Here, the protective roles of TFF peptides, FCGBP, and DMBT1^gp340 in saliva are discussed. TFF peptides are also used to reduce radiotherapy- or chemotherapy-induced oral mucositis. Thus, TFF peptides, FCGBP, and DMBT1^gp340 are promising candidates for better formulations of artificial saliva, particularly improving wound healing and antimicrobial effects even in the esophagus.

Effect of Artificial Aging on Mechanical and Tribological Properties of CAD/CAM Composite Materials Used in Dentistry

With easy-to-process 3D printing materials and fast production, the quality of dental services can be improved. In the conventional procedure, the dentist makes temporary crowns directly in the patient’s mouth, e.g., from the most commonly used bis-acrylic composites. Temporary crowns made directly in the office without the use of CAD/CAM are often of inferior quality, which directly results in impaired hygiene, poorer masticatory mechanics, greater deposition of plaque, calculus and sediment, and may adversely affect periodontal and gum health. The mechanical strength, resistance to aging and abrasion of 3D printing materials are higher than those of the soft materials used in conventional methods. This translates into durability. The patient leaves the surgery with a restoration of higher utility quality compared to the conventional method. The objective of the paper was to determine the influence of aging in artificial saliva of AM (additive manufacturing) orthodontic composites on their functional properties. For the purpose of the study, fillings well-known worldwide were selected. These were traditional UV-curable resins (M I, M II, M III, M V) and a hybrid material based on a UV-curable resin (M VI). Samples were stored in artificial saliva at 37 ± 1 °C in a thermal chamber for 6 months. Indentation hardness, frictional tests and sliding wear measurements were conducted. A comparison between various materials was made. Descriptive statistics, degradation coefficients, H²E, Archard wear and specific wear rate were calculated. The Weibull statistical test for indentation hardness was performed and Hertzian contact stresses for the frictional association were calculated for unaged (M I, M II, M III, M V, M VI) and aged (M I AS, M II AS, M III AS, M V AS, M VI AS) samples. M I exhibited the lowest average hardness among the unaged materials, while M III AS had the lowest average hardness among the aged materials. Comparably low hardness was demonstrated by the M I AS material. The coefficient of friction values for the aged samples were found to be higher. The lowest wear value was demonstrated by the M I material. The wear resistance of most of the tested materials deteriorated after aging. The M VI AS material had the highest increase in wear. According to the results provided, not only the chemical composition and structure, but also aging have a great impact on the indentation hardness and wear resistance of the tested orthodontic materials.

The Potential of Hydroxyapatite Toothpaste to Prevent Root Caries: A pH-Cycling Study

PURPOSE

The effectiveness of a hydroxyapatite (HAP) toothpaste and a fluoride toothpaste in preventing root tissue demineralization (root caries) was compared using an established pH-cycling caries model.

MATERIALS AND METHODS

Sixty dentin blocks were produced from the root tissue of extracted human teeth and were assigned to 3 test groups (n=20/group): 10% hydroxyapatite toothpaste (HAP), 1450 ppm fluoride toothpaste (fluoride), and artificial saliva (artsaliva). Early root caries lesions were developed in each sample by 7-day demineralization using a pH-cycling caries model. The daily cyclic treatment regimen consists of two 2-minute toothpaste-slurry treatment periods, one 6-hour acid challenge using acidified gel (pH 4.5), and then storage in remineralizing solution (artsaliva) for the rest of the time. Demineralization was assessed as the amount of mineral loss (∆z) using transverse microradiography (TMR). Pairwise comparisons (between treatments) were performed using analysis of variance (ANOVA), and then Tukey's HSD for multiple comparisons. All p-values are considered significant if p<0.05.

RESULTS

Both ANOVA and Tukey's HSD indicated no significant (ANOVA; n=20) difference in mean ∆z among the groups, with least ∆z (±Sd) in the HAP (1117±366) compared to fluoride (1392±334) and artsaliva (1406±223). Relative to control, HAP and fluoride inhibited root demineralization by 21% and 6%, respectively.

CONCLUSION

Within the limit of the present study, the tested toothpaste containing 10% HAP is an effective root caries control toothpaste. Toothpaste containing 10% HAP was slightly more effective in preventing tooth demineralization than 1450 ppm fluoride provided as sodium fluoride. Thus, this study shows that HAP toothpastes can serve as an effective alternative to fluoride toothpastes for root caries management.

Influence of Build Orientation, Geometry and Artificial Saliva Aging on the Mechanical Properties of 3D Printed Poly(ε-caprolactone)

Additive manufacturing of polymers has evolved from rapid prototyping to the production of functional components/parts with applications in distinct areas, ranging from health to aeronautics. The possibility of producing complex customized geometries with less environmental impact is one of the critical factors that leveraged the exponential growth of this processing technology. Among the several processing parameters that influence the properties of the parts, the geometry (shape factor) is amid less reported. Considering the geometric complexity of the mouth, including the uniqueness of each teething, this study can contribute to a better understanding of the performance of polymeric devices used in the oral environment for preventive, restorative, and regenerative therapies. Thus, this work aims to evaluate 3D printed poly(ε-caprolactone) mechanical properties with different build orientations and geometries. Longitudinal and transversal toolpaths produced specimens with parallelepiped and tubular geometry. Moreover, as it is intended to develop devices for dentistry, the influence of artificial saliva on mechanical properties was determined. The research concluded that the best mechanical properties are obtained for parallelepiped geometry with a longitudinal impression and that aging in artificial saliva negatively influences all the mechanical properties evaluated in this study.

Could the use of saliva substitutes improve food oral processing in individuals with xerostomia? A systematic review

Xersotomia is associated with food avoidance and low nutritional assessment. This review seeks to document whether products called "saliva substitutes" or "artificial saliva" can really replace saliva in food oral processing. Pubmed and Science Direct were searched for articles using the keywords "saliva substitutes" and "artificial saliva." An advanced search was applied using the terms "xerostomia" and/or "food oral processing" and/or "eating" and/or "mastication" and/or "chewing" and/or "swallowing." The analysis methods and the inclusion criteria were documented in a protocol published in the International prospective register of systematic reviews (PROSPERO with the registration number CRD42019124585). The search included 43 articles, published between 1979 and 2017. Among the included studies, 17 were observational studies, 5 were pilot studies, 21 were crossover studies, and 14 of these studies were blinded. The Strobe score for the included articles varied from 7.5 to 20. The possible effects of the use of saliva substitutes on the ingestion function were poorly investigated. No evidence was based on physiological studies. It is unknown whether using a saliva substitute has an effect on the composition and rheological properties of the food bolus, on the lubrication of the oral and laryngeal mucosa or on both phenomena. Moreover, saliva substitutes were not formulated to improve food oral processing and most of them are flavored. New saliva substitutes and artificial saliva should be designed and formulated to improve food oral processing.

Interaction of storage medium and silver diamine fluoride on demineralized dentin

Objective

The effects of saliva on demineralized dentin and silver diamine fluoride (SDF) were investigated in vitro.

Methods

Dentin samples stored in deionized water (DIW), buffer solution (BS), basal medium mucin (BMM), and unstimulated whole saliva (UWS) were demineralized for 3 days and immersed in the same storage media. SDF as a 38 mass% solution was applied to the dentin samples for 3 minutes after they had been replaced in their respective medium. Surfaces were analyzed by scanning electron microscopy, energy-dispersive X-ray analysis (EDX), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD).

Results

Scanning electron microscopy showed various surface deposits and coatings, including occlusion of dentinal tubules. DIW resulted in the thinnest coating, whereas BMM resulted in the thickest. EDX and XPS showed the formation of metallic silver and silver compounds in all four media, with the greatest formation in BS. XRD indicated that the main product was silver chloride except in DIW. Sulphur was found in BMM and UWS. EDX and XPS detected fluoride and XRD detected calcium fluoride and fluorohydroxyapatite in BS, BMM, and UWS.

Conclusion

The interaction between SDF and demineralized dentin was dependent upon the storage medium. BMM provided an outcome most similar to human saliva.

Long-Term Assessment of the In Vitro Corrosion Resistance of Biomimetic ACP Coatings Electrodeposited from an Acetate Bath

Calcium phosphate coatings are able to improve the osseointegration process due to their chemical composition, which is similar to that of bone tissues. In this work, to increase the long-term corrosion resistance and to improve the osseointegration process of commercially pure titanium Grade 4 (CpTi G4), biomimetic amorphous calcium phosphate (ACP) coatings were electrodeposited for the first time from an acetate bath with a pH level of 7.0 and a Ca:P ratio of 1.67. ACP coatings were obtained on CpTi G4 substrate subjected to sandblasting and autoclaving using electrochemically assisted deposition at a potential of -3 V relative to the open circuit potential for 30 min at room temperature. SEM, EDS, 2D roughness profiles, amplitude-sensitive eddy current method, and Kelvin scanning probe were used for the surface characterization of the biomaterial under study. In vitro corrosion resistance tests were conducted for 21 days in artificial saliva using open circuit potential, polarization curves, and electrochemical impedance spectroscopy measurements. The passive-transpassive behavior was revealed for the obtained ACP coatings. The long-term corrosion resistance test showed a deterioration of the protective properties for CpTi G4 uncoated and coated with ACP with immersion time. The mechanism and kinetics of the pitting corrosion on the CpTi G4|TiO2|ACP coating system are discussed in detail.

Effect of Nano-Filled Protective Coating and Different pH Enviroment on Wear Resistance of New Glass Hybrid Restorative Material

The purpose of the study was to determine the wear rate of Equia Forte HT Fil with Equia Forte Coat or without coating and compare it with Fuji IX GP high-viscosity glass ionomer cement (GIC) in conditions with acid load or at neutral pH. The samples were stored for 7 days: (1) in artificial saliva, (2) in artificial saliva and cyclically exposed to low pH, and (3) in distilled water and cyclically exposed to low pH. Wear was determined by measuring the difference in mass before and after brushing in an abrasion testing device. The wear of Fuji IX GP was significantly higher than that of Equia Forte HT Fil with or without coating (p = 0.000). The difference between Equia Forte HT Fil with and without Coat was not statistically significant (p < 0.803). The differences in wear resistance between samples stored in saliva and in distilled water were not significant (p = 0.588). Periodic exposure to the low pH solution significantly affected the wear resistance of all materials (p = 0.000). Equia Forte HT Fil was more resistant to wear than Fuji IX GP in all storage conditions. A resinous coat did not significantly increase wear resistance.

Effect of artificial saliva on the mechanical properties of a polymer material reinforced with fiber, used in esthetic tooth restorations

BACKGROUND

The oral environment can negatively affect the physical properties of fiber-reinforced composite (FRC) materials, which can lead to the deterioration of mechanical stability and reduce the span of their clinical usefulness.

OBJECTIVES

The aim of this study was to determine the influence of artificial saliva on the selected mechanical properties of FRC.

MATERIAL AND METHODS

The core of the polymer material selected for the study was a bundle of ultrahighmolecular-weight polyethylene (UHMWPE) fibers. Fourteen samples were stored in an incubator at 37°C, in 20 mL of artificial saliva solution, and weighed on days 1 and 28. At the same time, mechanical tests were performed, including the measurements of Young's modulus, tensile stress, maximum tensile force, and tensile deformation.

RESULTS

The analysis of basic statistics together with the results of the Shapiro-Wilk test and the distribution of Spearman's rho coefficient showed a strong negative relationship between the pair of variables - tensile deformation and the sorption of synthetic saliva. The results related to Young's modulus of elasticity and tensile stress were not statistically significant.

CONCLUSIONS

Water penetration into the space between the fibers does not adversely affect the mechanical properties of the material tested. In the static tensile test, high and desired mechanical strength was observed, which may justify the effective use of this type of material in clinical practice and may be a good alternative to prosthetic restorations, whose retention is obtained only through a mechanical connection with the abutment tooth.

Impact of Wound Closure on the Corrosion Rate of Biodegradable Mg-Ca-Zn Alloys in the Oral Environment

Magnesium alloys have exhibited a rapid rate of corrosion and thus early implant failure, so this study was designed to investigate the longer-term effects and in particular on wound closure. The aim of the study is to evaluate Mg-Ca-Zn Alloys as promising biodegradable implants in the field of maxillofacial surgery, which have so far never been evaluated for the changing conditions from a saliva to a serum-like environment after wound closure. Magnesium-0.6/calcium-0.8 wt.% zinc alloys were either immersed for 10 days in artificial saliva or 10 days in Hank's salt solution as control groups. The test group was transferred from artificial saliva to Hank's salt solution after 5 days in order to simulate wound closure. Corrosion rates were determined by immersion testing. Additional electron microscopy and energy dispersive X-ray spectroscopy (EDX) were performed. Prior artificial saliva exposure led to significantly decreased (p = 0.0272) corrosion rates after transfer to Hank's solution in comparison to sole Hank's solution exposure (0.1703 vs. 0.6675 mg/(cm²·day)) and sole artificial saliva exposure (0.3180 mg/(cm²·day)), which both exhibit a strong increase after 5 days. The results were in accordance with the scanning electron microscopy and EDX pictures. Prior saliva exposure could protect from increasing corrosion rates after wound closure. Thus Mg-Ca-Zn Alloys are promising future implant alloys in oral surgery, whereas other surgical fields without saliva exposure have to deal with accelerated corrosion rates after 5 days.

Long-Term Sorption and Solubility of Zirconia-Impregnated PMMA Nanocomposite in Water and Artificial Saliva

Exposure of denture base acrylic resins to the oral environment and storage media for extended periods of time results in sorption of saliva or water, leading to a reduction in physical properties and thus clinical service life. The purpose of this in vitro study was to assess the sorption and solubility of high-impact heat-polymerised denture base acrylic resin (HI PMMA) impregnated with zirconia nanoparticles after being stored for 180 days in distilled water (DW) and artificial saliva (AS). The specimens were divided into six groups for each storage medium, according to the concentration of zirconia nanoparticles (0, 1.5, 3.0, 5.0, 7.0, and 10.0 wt.%). Data were statistically analysed for sorption and solubility using one-way and two-way ANOVA statistical tests. Sorption in DW and AS for all groups containing zirconia showed sorption values lower than the control group at 90 days, though not significantly different (p > 0.05) compared to the control group. For both the DW and AS groups, the lowest solubility value was measured in the group containing 3 wt.% zirconia, however, there was no significant difference compared to the control group except when observing 10 wt.% zirconia in AS, which showed a significantly higher solubility (p < 0.05). High-impact PMMA, impregnated with low concentrations of ZrO₂, showed the lowest sorption and solubility in both media, but was not significantly different compared to pure HI PMMA.

Validation of a Simple HPLC-UV Method for the Determination of Monomers Released from Dental Resin Composites in Artificial Saliva

Bisphenol-A (BPA), bisphenol A glycerolate dimethacrylate (Bis-GMA), triethylene glycol dimethacrylate (TEGDMA), and urethane dimethacrylate (UDMA) are organic monomers that can be released from dental composites into the oral cavity. Over specific concentrations, they can act as endocrine disruptors or cause toxic effects. The purpose of this work is to develop and validate an analytical method to determine BPA, Bis-GMA, TEGDMA, and UDMA monomers released from synthetic dental resins in artificial saliva. The method was validated before its application to new hybrid ceramic materials used in computer-aided design and computer-aided manufacturing (CAD/CAM) restorations to determine the release of monomers in various time intervals (e.g., 24 h, and 7, 14, 30, and 60 days), both in methanolic solutions, as well as in artificial saliva. Chromatographic analysis was performed isocratically on a Perfect Sil Target ODS-3 analytical column (250 mm × 4.6 mm, 5 µm) with CH₃CN/H₂O, 58/42% v/v as mobile phase within 23 min. The developed method was validated in terms of selectivity, linearity, accuracy, and precision.

Electrochemical Performance of Fe40Al-X (X = Cr, Ti, Co, Ni) Alloys Exposed to Artificial Saliva

Fe–Al intermetallic compounds have been considered excellent candidates as alternative alloys for various applications in corrosive environments compared to other Fe-based alloys. Their excellent corrosion resistance is due to the development of an Al-based passive layer. The performance of the passive layer can be improved by adding a third alloy element. Therefore, in this study the electrochemical performance of the Fe40Al intermetallic alloy modified by the addition of a third alloy element (Cr, Ti, Co, Ni) is evaluated. The corrosion resistance of intermetallic alloys has been evaluated by electrochemical tests (potentiodynamic polarization curves, and measurements of open circuit potential, linear polarization and electrochemical impedance) in artificial saliva. The performance of intermetallic alloys was compared with that of Ti. The results obtained showed that the addition of Ni and Ti substantially improves the corrosion resistance of the base intermetallic. The corrosion resistance shown is comparable or greater than that shown by Ti. However, the addition of Co reduces the corrosion resistance of the base intermetallic.

Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia

The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.

The effect of esterase enzyme on aging dental composites

We measured the push-out and diametral tensile strength of dental restorative composites following aging under environmental conditions relevant to the oral cavity; air (A), artificial saliva (AS), acidified (50 mM CH₃ COOH, pH = 4.7) artificial saliva (AS + HAc), and AS with esterase enzyme (AS + ENZ). Cylindrical test specimens (6.3 mm diameter by 5.1 mm long) were prepared by placing 0.3 g of nanofilled composite in an epoxy ring and cured. Twenty samples were aged in each environment for 163-186 days at 37°C. The push-out strengths (mean ± standard error of the mean [SEM], in MPa) for specimens were: A-2.4 ± 0.2, AS-7.3 ± 0.5, AS + HAc-7.2 ± 0.9, and AS + ENZ-6.0 ± 0.6. Following the push-out test, the diametral tensile strength and elasticity were immediately determined. The diametral tensile strengths (mean ± SEM, in MPa) for specimens were: A-54.0 ± 1.6, AS-31.4 ± 1.3, AS + HAc-34.3 ± 1.2, and AS + ENZ-22.5 ± 0.7. The push-out strength was lowest for the A environment due to shrinkage of the composite. The push-out strength increased significantly as water diffused into the specimens (AS and AS + HAc) but decreased significantly in the enzyme environment (AS + ENZ). The diametral tensile strength was highest for specimens in the A environment, which was significantly higher than both the AS and AS + HAc specimens and > 2× higher than the AS + ENZ specimens. The results indicated that a water environment (with or without acid) caused a significant decrease in the mechanical properties of this composite, but the greatest decrease was seen in water with esterase. This is the first study to demonstrate that esterase enzymes affect the bulk strength of a commonly used commercial dental composite. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2178-2184, 2019.

Silver deposition on demineralized dentine surface dosed by silver diammine fluoride with different saliva

AIM

Silver diammine fluoride (SDF) is an anticaries agent that binds to tooth tissue. The aim of the present study was investigate the dose-response effect of SDF on demineralized dentine in basal medium mucin (BMM) saliva substitute and human saliva.

METHODS

Dentine discs stored in saliva substitute, BMM, and human unstimulated whole saliva (UWS) were chemically demineralized, and 10 μL of 10 wt%, 24 wt%, or 38 wt% SDF was applied and then stored in its respective saliva (BMM or UWS) for 5 days. Dentine disc samples were digested in 70% HNO₃ , and silver was quantitatively detected by inductively coupled plasma mass spectroscopy.

RESULTS

For both the BMM and UWS groups, the presence of silver increased proportionally with increasing concentrations of SDF (P < 0.05). For the 38 wt% SDF application, the mean absorption percentage of silver in dentine was 3.90% for the UWS group and 6.61% for the BMM group. The BMM group was found to yield a significantly higher amount of silver compared to UWS at 10 wt% and 38 wt% SDF application (α = 0.05); 38 wt% SDF interacts more with BMM with higher silver deposition than UWS.

CONCLUSION

The amount of silver found in dentine was in proportion to the concentration of SDF. Extrapolation of in vitro investigations using artificial saliva for SDF tooth interactions should be interpreted with caution.

Preliminary Comparative Study of Oral7® Versus Salt-Soda Mouthwash on Oral Health Related Problems and Quality of Life among Head and Neck Cancer Patients Undergoing Radiotherapy

Background

This quasi-clinical trial compared the effects of Oral7^® and salt-soda mouthwash on the development of dental caries, salivary gland function, radiation mucositis, xerostomia and EORTC QLQ H&N C35 scores in head and neck cancer patients who underwent radiotherapy.

Methods

We included patients with histopathologically diagnosed head and neck cancers who had received radiation, with an Eastern Cooperative Oncology Group (ECOG) performance status 0–1 and age range of 15–60 years. Patients with prior radiotherapy and chemotherapy, edentulous status, total parotidectomy, sicca syndrome or on xerosis-induced medications were excluded. We assigned 15 patients each to the Oral7^® and salt-soda groups.

Results

There was no significant difference in the mean Decayed, Missing and Filling Teeth (DMFT) score between groups. Head and neck cancer patients who were on Oral7^® had a significantly better quality of life than those on salt-soda in relation to the swallowing problems, social eating, mouth opening, xerostomia and illness scales. Patients who were on Oral7^® had a significantly lower xerostomia score than patients on salt-soda mouthwash. Patients on Oral7^® had a significantly lower mucositis score in week 5–7 compared to patients in the salt-soda group.

Conclusion

Oral7^® showed advantages over salt-soda solution in relation to reducing xerostomia, easing radiation-induced mucositis, and improving quality of life, despite the non-significant difference in the dental caries assessment.

In vitro oral processing of raw tomato: Novel insights into the role of endogenous fruit enzymes

During consumption of fruits, the breakdown of the fruit tissue due to oral processing (chewing, mixing with saliva) may activate or increase the rate of endogenous enzyme activities via the disruption of the cell wall, cellular decompartmentalization, and particle size reduction allowing the enzymes to reach their substrates. The aim of this study was to investigate the activity of one such endogenous fruit enzyme (pectin methylesterase [PME] [E.C. 3.1.1.11]) during in vitro oral processing of raw tomatoes and associated changes in viscosity and microstructure. Oral processing of tomatoes purees was examined in the presence of artificial saliva (AS) at 37°C. in vitro oral processing was followed using immunofluorescence microscopy, apparent viscosity measurements, spectrophotometric, and titrimetric techniques. The results demonstrated that PME had slight but significant activity in the tomato fruit during in vitro oral processing generating methanol as a function of oral processing time, which was further evidenced using immunolabeling techniques to detect methylated pectin epitopes. A significant shear-thinning behavior of the tomato puree was observed due to dilution and/or endogenous fruit enzyme activity. These results suggest that activity of other fruit enzymes, such as polygalacturonase, which catalyzed the depolymerization of unmethylated pectin chains, might have resulted in a decrease in viscosity, which compensated for the increased potential for gel formation (if any) caused by PME. These interesting insights into the role of endogenous fruit enzymes might pave the way to the understanding of fruit viscosity modification occurring in the mouth and help in rational design of new fruit-based products.

Streptococcus Sanguis Biofilm Architecture and Its Influence on Titanium Corrosion in Enriched Artificial Saliva

Bacteria biofilm formation on metals is well-known, while biofilm architecture varies under different conditions. To date, few studies have determined the possible contribution to corrosion of titanium made by biofilm architecture. We investigated the interaction between the oral Streptococcus sanguis biofilm architecture and its influence on titanium corrosion in enriched artificial saliva using electrochemical methods and microscopic study. Patchy biofilms were observed on titanium surface after being immersed in solution containing S. sanguis. The thickness and size of the patchy biofilms increased with an increase of immersion time. The extensive pits were clearly observed by scanning electron microscopy, showing that adsorption of S. sanguis on titanium promoted the localized corrosion. The electrochemical results indicated that the corrosion rates were clearly accelerated in the presence of S. sanguis. The low i_corr and high R_t in the first 48 h indicated that a typical passive behavior still remained. Our study showed that the pitting corrosion of titanium was mainly attributed to the formation of a self-catalytic corrosion cell by the co-effect of patchy biofilm and organic acid secreted by S. sanguis.

Ruminal phytate degradation of maize grain and rapeseed meal in vitro and as affected by phytate content in donor animal diets and inorganic phosphorus in the buffer

The ruminal disappearance of phytate phosphorus (InsP₆ -P) from maize grain and rapeseed meal (RSM) was determined in two in vitro studies. In experiment 1, two diets differing in phosphorus (P) and InsP₆ -P concentration were fed to the donor animals of rumen fluid (diet HP: 0.49% P in dry matter, diet LP: 0.29% P). Maize grain and RSM were incubated in a rumen fluid/saliva mixture for 3, 6, 12 and 24 h. In experiment 2, a diet similar to diet HP was fed, and the rumen fluid was mixed with artificial saliva containing 120 mg inorganic P/l (Pi) or no inorganic P (P0). Maize grain and RSM were incubated with either buffer for 3, 6, 12 and 24 h. Total P (tP) and InsP₆ concentration were analysed in the fermenter fluids and feed residues. The disappearance of InsP₆ -P from maize was completed after 12 h of incubation in both experiments. From RSM, 93% (diet LP) and 99% (diet HP) of the InsP₆ -P in experiment 1 and 80% (Pi) and 89% (P0) in experiment 2 had disappeared after 24 h of incubation. InsP₆ -P disappearance was higher when diet HP was fed (maize: 3 and 6 h; RSM: 6 and 24 h of incubation) and when rumen fluid was mixed with buffer P0 (maize: 6 h; RSM: 12 and 24 h of incubation). InsP₆ -P concentration in the fermenter fluids was higher for maize, but no accumulation of InsP₆ -P occurred, indicating a prompt degradation of soluble InsP₆ . These results confirmed the capability of rumen micro-organisms to efficiently degrade InsP₆ . However, differences between the feedstuffs and diet composition as well as the presence of inorganic P in the in vitro system influenced the degradation process. Further studies are required to understand how these factors affect InsP₆ degradation and their respective relevance in vivo.

Influence of different lubricants on the retentive force of LOCATOR(®) attachments - an in vitro pilot study

OBJECTIVE

The aim of this in vitro pilot study was to evaluate the influence of an artificial saliva (AS) lubricant on the retentive force of a stud-type attachment (LOCATOR(®) ) for implant overdentures (IODs).

METHODS

Twenty custom-made models simulating a two-IOD with parallel implant situation were fabricated using LOCATOR(®) attachments. The in vitro testing was carried out with an Instron(®) universal testing machine for a total of 10,000 insertion-removal cycles, for each model, in two different aqueous test mediums (Group 1: 0.9% sodium chloride solution (NaCl), n = 10; Group 2: AS, n = 10). Changes in the mean retentive force (F) were plotted against the cycle numbers #10, #100, #1000, #5000, and #10,000. Mixed regression models were applied for statistical analyses.

RESULTS

A mixed regression (not considering interactions) predicted, compared to cycle #10, higher retentive forces at cycles #100 (P < 0.0001), #1000 (P = 0.017), similar forces at #5000 (P = 0.277), and lower forces at #10,000 (P = 0.012); there was no overall effect of the medium (P = 0.159). A second statistical model, employing the interaction term "cycle##medium", confirmed similarly the effect. Although the interaction term was significant at cycle #100 (p = 0.045), there was no significant difference between the two groups (P = 0.140).

CONCLUSION

In this in vitro pilot experiment, there was no difference in mean retentive forces of the LOCATOR(®) attachments when tested with either 0.9% NaCl or a Glandosane(®) -like artificial saliva lubricant. A larger scale study may still confirm the superiority of either lubricant for quasiclinical bench experiments.

Electrochemical behaviour of a cobalt-chromium-molybdenum dental alloy in artificial salivas: Influence of phosphate ions and mucin components

The stability of the Co-Cr-Mo dental alloy immersed in artificial salivas (pH 6.7) was investigated over 24 h. Three artificial salivas have been studied: saline saliva (saliva I); saline saliva buffered with phosphate ions (saliva II) and saliva II plus mucin molecules (saliva III). For all the systems, open circuit potential shift positively over 24 hours of immersion. Data extracted from the steady-state polarization curves demonstrated that the Co-Cr-Mo alloy has higher corrosion potential in saliva III, lower corrosion potential in saliva I and lower initial corrosion resistance in saliva III. After 24 hours of immersion in the artificial salivas, the Co-Cr-Mo alloy presents high corrosion stability, due to the protective action created by the presence of corrosion products. From the analysis of the breakdown potential it was concluded that, the presence of the phosphate ions and mucin promote the oxidation process, inducing the formation of etch pits. Regarding the effect of the mucin concentration in the corrosion behaviour of the Co-Cr-Mo dental alloy, it was observed a negative shift in the corrosion potential, pointing to a cathodic inhibitor role for the mucin molecules. Nevertheless, no correlation between the mucin concentration and corrosion rate was possible to establish.

[Comparison of friction force between Lock-loose bracket and traditional bracket]

OBJECTIVE

Frictions of Lock-loose brackets with ligated main wings or all six wings were measured as they slid along archwires in dry and artificial saliva environments. The Lock-loose brackets were then compared with traditional brackets and self-ligating brackets.

METHODS

The surface states of the stainless steel archwires were observed with atomic force microscopy before and after mechanical traction. The Lock-loose brackets, traditional brackets, and self-ligating brackets used in this study were composed of 0.406 4 and 0.457 2 mm stainless steel round archwires and 0.457 2 mm x 0.634 9 mm and 0.482 6 mm x 0.634 9 mm stainless steel rectangular archwires. Two different ligating methods were applied to the Lock-loose brackets, i.e., main wings ligated and all six wings ligated. Frictions were measured by using an electronic universal testing machine.

RESULTS

No significant differences were found between the roughness of different archwires before and after mechanical traction in different brackets (P > 0.05). When the main wings of the Lock-loose brackets were ligated, the frictions of the four different stainless steel archwires were close to zero, and the difference with frictions of traditional brackets was significant (P < 0.05). When using 0.457 2 mm x 0.634 9 mm rectangular archwires, maximum friction (P < 0.05; significantly different from those of other brackets) was reached when all six wings of the Lock-loose brackets were ligated. Frictions in the dry state were higher than those in the wet state (P < 0.05).

CONCLUSION

The Lock-loose brackets can adjust the friction efficiently with different ligating methods, thus solving the problem of low friction and strengthening anchorage.

Xerostomia in geriatric patients: a burgeoning global concern

Saliva plays a key role in maintaining oral homeostasis, function, and health. The prevalence of xerostomia and its consequences are rising due to the increasing aging population, the effects of some systemic diseases, medical management, and commonly-prescribed medications that reduce saliva production. When salivary function is diminished, patients are at a greater risk of developing caries, discomfort in wearing dentures, and opportunistic diseases, such as candidiasis. The psychosocial aspects of xerostomia can range from a mild effect on self-rated oral health to frustration, embarrassment, unhappiness, or substantial disruptions in quality of life. This article reviews the clinical features, diagnosis, and prevalence of dry mouth, as well as its treatment strategies.

Corrosion Behavior of Titanium in Artificial Saliva by Lactic Acid

As one of the main products produced by oral microorganisms, the role of lactic acid in the corrosion of titanium is very important. In this study, the corrosion behavior of titanium in artificial saliva with and without lactic acid were investigated by open-circuit potentials (OCPs), polarization curves and electrochemical impedance spectroscopy (EIS). OCP firstly increased with the amount of lactic acid from 0 to 3.2 g/L and then tended to decrease from 3.2 to 5.0 g/L. The corrosion of titanium was distinctly affected by lactic acid, and the corrosion rate increased with increasing the amount of lactic acid. At each concentration of lactic acid, the corrosion rate clearly increased with increasing the immersing time. Results of scanning electron microscopy (SEM) also indicated that lactic acid accelerated the pitting corrosion in artificial saliva. A probable mechanism was also proposed to explain the experimental results.

Evaluation of nickel ion release from various orthodontic arch wires: An in vitro study

Aim:

The high incidence of nickel (Ni) allergy and the increasing use of Ni-containing dental biomaterials have been of growing concern. The purpose of this investigation was to analyze and evaluate the rate of Ni ion release from different types arch wires used in orthodontics.

Materials and Methods:

Four groups of arch wires (nickel titanium [NiTi], SS, Cu NiTi and ion implanted NiTi) with twelve samples were stored in artificial saliva with a pH 5.6-7.0 thermostated at (36.5°C) and tested at different intervals i.e., 7^th day, 14^th day, and 21^st day. The amount of Ni and Ti ions released from the sample were evaluated using an atomic adsorption spectrophotometer. The solution was replaced with a fresh bottle to avoid sediments.

Results:

Statistical analysis was performed by nonparametric tests (Student's paired t-test, one-way analysis of variance and multiple comparison test by Tukey “Honestly significant difference”). The statistical package SPSS PC plus (version 4.0.1) was used for data processing and statistical analysis. Results showed significantly statistical influence on the release amount of Ni and Ti ions. Large variation in concentration of Ni released from brackets and bands combined. However, the amount of Ni ions released in all test solutions diminished with time and was below the critical value necessary to induce allergy and below daily dietary intake level.

Conclusions:

The daily release of NiTi, SS, Cu NiTi and ion implanted NiTi by an orthodontic appliance in acid pH, particularly favorable to corrosion, was well below that ingested with a normal daily diet. It is therefore concluded that the quantities of metal ions released in our experimental conditions should not be cause for concern in utilizing the appliance.

Release of metal ions from fixed orthodontic appliance: an in vitro study in continuous flow system

OBJECTIVE

To evaluate the release of metal ions from fixed orthodontic appliances.

MATERIALS AND METHODS

A new system for in vitro testing of dental materials was constructed and consisted of a thermostatic glass reactor that enabled immersion of the studied material. Experimental conditions reflected the human oral cavity, with a temperature of 37°C and a saliva flow rate of 0.5mL/min. The simulated fixed orthodontic appliance made of stainless steel was evaluated. Sampling was performed at several time points during the 28-day study, and the metal ion concentration was determined by inductively coupled plasma optical emission spectrometry.

RESULTS

The total mass of released metal ions from the appliance during 4 weeks of the experiment was as follows nickel 18.7 μg, chromium 5.47 μg, copper 31.3 μg.

CONCLUSIONS

The estimated doses of nickel, chromium, and copper determined by extrapolation of experimental data released during the treatment period were far below the toxic dose to humans. This shows that orthodontic treatment might not be a significant source of exposure to these metal ions.

Application of chlorhexidine, fluoride and artificial saliva during radiotherapy: an in vitro study of microleakage in Class V restorations

BACKGROUND

The aim of this study was to evaluate the effect on microleakage in Class V restorations of daily applications of artificial saliva, fluoride mouthrinses and chlorhexidine to irradiated bovine teeth.

METHODS

Class V cavities were created in 60 bovine teeth. The teeth were divided randomly into two groups: the first group (n = 30) was subjected to radiotherapy until the teeth had received a total accumulated dose of 60 Gy; the second group (n = 30) was used as a control group. Both groups were divided into three subgroups (n = 10): in Group A teeth were submerged in Xeros Dentaid(®) artificial saliva; Group B teeth were submerged in a solution of 1% amine fluoride; Group C teeth were submerged in 0.12% chlorhexidine. All treatments were applied three times a day for six weeks. Afterwards microleakage into the composite restorations was measured using MIP4 image software.

RESULTS

It was seen that radiation caused increases in microleakage in composite restorations. Statistically significant differences were found in the artificial saliva group (p = 0.013) and the chlorhexidine group (p = 0.023).

CONCLUSIONS

Microleakage in composite restorations was greater among radiated teeth.

Release of metal ions from orthodontic appliances: an in vitro study

In this paper, we report the results of an in vitro experiment on the release of metal ions from orthodontic appliances composed of alloys containing iron, chromium, nickel, silicon, and molybdenum into artificial saliva. The concentrations of magnesium, aluminum, silicon, phosphorus, sulfur, potassium, calcium, titanium, vanadium, manganese, iron, cobalt, copper, zinc, nickel, and chromium were significantly higher in artificial saliva in which metal brackets, bands, and wires used in orthodontics were incubated. In relation to the maximum acceptable concentrations of metal ions in drinking water and to recommended daily doses, two elements of concern were nickel (573 vs. 15 μg/l in the controls) and chromium (101 vs. 8 μg/l in the controls). Three ion release coefficients were defined: α, a dimensionless multiplication factor; β, the difference in concentrations (in micrograms per liter); and γ, the ion release coefficient (in percent). The elevated levels of metals in saliva are thought to occur by corrosion of the chemical elements in the alloys or welding materials. The concentrations of some groups of dissolved elements appear to be interrelated.

Streptococcus mutans, caries and simulation models

Dental caries and dental plaque are among the most common diseases worldwide, and are caused by a mixture of microorganisms and food debris. Specific types of acid-producing bacteria, especially Streptococcus mutans, colonize the dental surface and cause damage to the hard tooth structure in the presence of fermentable carbohydrates e.g., sucrose and fructose. This paper reviews the link between S. mutans and caries, as well as different simulation models that are available for studying caries. These models offer a valuable approach to study cariogenicity of different substrates as well as colonization of S. mutans.